Active surveillance for prostate cancer

Many men diagnosed with prostate cancer don’t need to be treated right away. This is because most prostate cancers grow slowly and are unlikely to spread outside of the prostate. Men with prostate cancer that has a very low risk of growing quickly or spreading may be offered active surveillance. This means that your healthcare team watches the cancer closely rather than giving treatment right away. They will use tests and exams to check if prostate cancer is progressing or your condition is getting worse. Treatment is given when you develop symptoms or the cancer changes.

Men older than 75 years of age with a low-risk prostate tumour are more likely to die from other diseases rather than from prostate cancer. These men are often unlikely to notice any signs or symptoms of cancer for many years. Active surveillance is often preferred to treatment in older men and those with severe medical problems, especially if they aren’t expected to live at least 10 years.

Using active surveillance helps avoid side effects that can happen with treatments such as surgery or radiation therapy. There is no evidence so far that people won’t live as long when they get active surveillance compared to other treatments. And there is no evidence that active surveillance has other negative effects if or when you start treatment.

Who is treated with active surveillance

You may be offered active surveillance if:

the cancer is low grade with a Gleason score of 6 or less

the cancer is intermediate grade with a Gleason score of 7 and it hasn’t spread outside of the prostate

the prostate-specific antigen (PSA) level is less than 10 ng/mL

the cancer isn’t causing any symptoms

you prefer not to have treatment right away so you can avoid treatment-related side effects and keep the quality of life that you’re used to

you are older or have severe medical problems, so your life expectancy is less than 10 years

Doctors may use the term “watchful waiting” instead of active surveillance for this last group of men. This is because the tests and doctor appointments happen less often than with active surveillance. The goal of any future treatment for these men is not to cure the cancer but to control their symptoms (called palliative treatment).

During active surveillance

You will have tests every 3 to 6 months to monitor the cancer. Tests may include:

PSA test

physical exam, including a digital rectal exam (DRE)

prostate biopsy

bone scan, chest x-ray or CT scan depending on the signs and symptoms that develop

MRI of the prostate in some cases

When treatments are started

Treatments, such as surgery or radiation therapy, are started if:

the PSA level keeps going up over time

samples from follow-up biopsies are given a higher Gleason score

symptoms develop and tests show the cancer is starting to grow

Some men find it reassuring to have treatments for prostate cancer even if they are unlikely to help them live longer. These men may be offered treatments soon after they are diagnosed.

Talk to your doctor about the advantages and disadvantages of active surveillance, treatment options and their potential side effects. This will help you to choose the treatment option that is best for you.